DIAGNOSTICS FOR A PREGNANT WOMAN

NOTES IN MATERNAL AND CHILD NURSING
Reference: NURSE’S NOTES: MATERNAL and CHILD NURSING
Maritess Manalang-Quinto, RN, MAN(c)

DIAGNOSTICS FOR PREGNANT WOMEN on the FIRST PRENATAL VISIT
Gravidity and Parity
Gravidity: number of pregnancies
Parity: number of births
Use of GTPALM
G: number of pregnancies
T: term births
P: preterm births
A: abortions (included in gravida is before 20 weeks
L: living children
M: Multiple Pregnancies

Clean Catch Urine
Used to check the presence of urinary tract infection during pregnancy
Pain upon urination is a common sign of urinary tract infection especially during pregnancy
Able to identify presence of HCG as indicative of pregnancy

Laboratory Tests
Radioimmunoassay test
Enzyme linked immunosorbent assay
Radioreceptor assay
Test for the first 24-48 hours after implantation
50 mIU/ml 7 to 9 days after conception
Peaks to 100 ml between 60th and 80th week of gestation

Pelvic Examination
Bimanual examination
Notes ovarian cysts, enlarged fallopian tubes, enlarged uterus, Hegar’s sign
Estimating Pelvic Size
Type of Pelvis: Android, Anthropoid, Gynecoid, Platypelloid
Diagonal conjugate: distance between the anterior surface of the inferior margin of the symphysis pubis
more than 12.5 cm
Ischial Tuberosity diameter: distance between the ischial tuberosities or transverse diameter of the outlet
9-11 cm is adequate

Assessment of Fetal Growth
Nagele’s Rule
- determines estimated birth date
McDonald’s Rule
- estimates fetal growth in utero
- fundic height or uterine height
Assessment of Fetal Well Being
- FHR
- Fetal movement
- Fetal presentation and position
-Leopolds maneuver
Late decelerations
Uteroplacental insufficiency
Begins well after the contraction but returns to baseline after 30 to 40 seconds

VARIABLE DECELERATIONS
Occurs at any time during uterine contracting phase
Decrease is usually >15bpm, lasts 15secs, return to baseline in <2mins from onset = indicates cord compression
NSG INTERVENTIONS:
Change in the mother’s position
Administer O2
D/C oxytocin

Alpha fetoprotein screening test
Assess the quantity of fetal serum proteins
Elevated levels of protein are associated with open neural tube and abdominal defects
Blood sample drawn at 15 to 18 weeks AOG

Amniocentesis
Aspiration of amniotic fluid done 13 to 14 weeks AOG
Performed to determine genetic disorders, metabolic defects and fetal lung maturity
Risks:
Maternal hemorrhage
Infection
Isoimmunization
Abruptio placentae
Amniotic fluid embolism
PROM

Nitrazine Test
Used to detect the presence of amniotic fluid
Amniotic has ph of 7 to 7.5 and turns yellow nitrazine to blue to blue green
Vaginal secretions have a ph of 4.6 to 7

Non stress test
Evaluates fetal heart rate in response to fetal movement
Results:
Unsatisfactory
Cannot be interpreted as a result of poor fetal tracing
Reactive: (negative)
Healthy fetus
2 or more FHR accelerations of at least 15 beats per minute lasting at least 15 seconds during a 20minute period
Non reactive: (positive)
No accelerations of at least 15 beats per minute or lasting less than 15 seconds in duration during a 40minute period

KICK COUNTS
Pregnant client should sit or lie quietly on her side.
Place hands on the largest area of the abdomen & concentrate on fetal movements.
Record the number of movements felt during a specific time period.
< 10 kicks in 12hr-period = NOTIFY MD

Fetal Monitoring
Displays the fetal heart rate
Monitors uterine activity which assesses the frequency, duration and intensity of contractions
A tocotransducer is placed over the fundus where contractions are felt strongest
Percutaneous Umbilical Cord Sampling
Cordocentesis or funicentesis
Blood studies to check blood count, blood gases, and isoimmunization
Changes during Pregnancy